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How to Know a Health Professional is not
Supportive of Breastfeeding

All health professionals say they are supportive of breastfeeding. But many are supportive only when
breastfeeding is going well, and some, not even then. As soon as breastfeeding, or anything in the life
of the new mother is not perfect, too many advise weaning or supplementation. The following is a list
of clues which help you judge whether the health professional is supportive of breastfeeding, at least
supportive enough so that if there is trouble, s/he will make efforts to help you continue

How to know a health professional is not supportive:

1. S/he gives you formula samples or formula company literature when you are pregnant, or after you
have had the baby. These samples and literature are inducements to use the product, and their
distribution is called marketing. There is no evidence that any particular formula is better or worse
than any other for the normal baby. The literature or videos accompanying samples are a means of
subtly and not so subtly undermining breastfeeding and glorifying formula. If you do not believe this,
ask yourself why the formula companies are using cutthroat tactics to make sure that your doctor or
hospital gives out their literature and samples and not other companies’? Should you not also wonder
why the health professional is not marketing breastfeeding?

2. S/he tells you that breastfeeding and bottle feeding are essentially the same. Most bottle fed
babies grow up healthy and secure and not all breastfed babies grow up healthy and secure. But this
does not mean that breastfeeding and bottle feeding are essentially the same. Infant formula is a
rough approximation of what we knew several years ago about breastmilk which is in itself a rough
approximation of something we are only beginning to get an inkling of and are constantly being
surprised by. The differences have important health consequences. Certain elements in breastmilk
are not in artificial baby milk (formula) even though we have known of their importance to the baby
for several years—for example, antibodies and cells for protection of the baby against infection, and
long chain polyunsaturated fatty acids for optimal development of the baby’s vision and brain. And
breastfeeding is not the same as bottle feeding, it is a whole different relationship. If you have been
unable to breastfeed, that is unfortunate (though most times the problems could have been avoided),
but to imply it is of no importance is patronizing and just plain wrong. A baby does not have to be
breastfed to grow up happy, healthy and secure, but it is an advantage.

3. S/he tells you that formula x is best. This usually means that s/he is listening too much to a
particular formula representative. It may mean that her/his children tolerated this particular formula
better than other formulas. It means that s/he has unsubstantiated prejudices.

4. S/he tells you that it is not necessary to feed the baby immediately after the birth since you are
(will be) tired and the baby is often not interested anyhow. It isn’t necessary, but it is very helpful.
Babies can nurse while the mother is lying down or sleeping, though most mothers do not want to
sleep at a moment such as this. Babies do not always show an interest in feeding immediately, but
this is not a reason to prevent them from having the opportunity. Many babies latch on in the hour or
two after delivery, and this is the time which is most conducive to getting started well, but they can’t
do it if they are separated from their mothers. If you are getting the impression that the baby’s getting
weighed, eye drops and vitamin K injection have priority over establishing breastfeeding, you might
wonder about someone’s commitment to breastfeeding.

5. S/he tells you that there is no such thing as nipple confusion and you should start giving bottles
early to your baby to make sure that the baby accepts a bottle nipple. Why do you have to start
giving bottles early if there is no such thing as nipple confusion? Arguing that there is no evidence for
the existence of nipple confusion is putting the cart before the horse. It is the artificial nipple, which
no mammal until man had ever used, and even man, not commonly before the end of the nineteenth
century, which needs to be shown to be harmless. But the artificial nipple has not been proved
harmless to breastfeeding. The health professional who assumes the artificial nipple is harmless is
looking at the world as if bottle feeding, not breastfeeding, were the normal physiologic method of
infant feeding. By the way, just because not all or perhaps even not most babies who get artificial
nipples have trouble with breastfeeding, it does not follow that the early use of these things cannot
cause problems for some babies. It is often a combination of factors, one of which could be the using
of an artificial nipple, which add up to trouble.

6. S/he tells you that you must stop breastfeeding because your are sick or your baby is sick, or
because you will be taking medicine or you will have a medical test done. There are occasional, rare,
situations when breastfeeding cannot continue, but often health professionals only assume that the
mother cannot continue and often they are wrong. The health professional who is supportive of
breastfeeding will make efforts to find out how to avoid interruption of breastfeeding (the information
in white pages of the blue Compendium of Pharmaceutical Specialties is not a good
reference—every drug is contraindicated according to it as the drug companies are more interested
in their liability than in the interests of mothers and babies). When a mother must take medicine, the
health professional will try to use medication which does not require the mother to stop
breastfeeding. (In fact, very few medications require the mother to stop breastfeeding). It is
extremely uncommon for there to be only one medication which can be used for a particular
problem. If the first choice of the health professional is a medication which requires you to stop
breastfeeding, you have a right to be concerned that s/he has not really thought about the importance
of breastfeeding.

7. S/he is surprised to learn that your 6 month old is still breastfeeding. Many health professionals
believe that babies should be continued on artificial baby milk for at least nine months and even
twelve months, but at the same time seem to believe that breastmilk and breastfeeding are
unnecessary and even harmful if continued longer than six months. Why is the imitation better than
the original? Shouldn’t you wonder what this line of reasoning implies? In most of the world,
breastfeeding to 2 or 3 years of age is common and normal.

8. S/he tells you that there is no value in breastmilk after the baby is 6 months or older. Even if it
were true, there is still value in breastfeeding. Breastfeeding is a unique interaction between two
people in love even without the milk. But it is not true. Breastmilk is still milk, with fat, protein,
calories, vitamins and the rest, and the antibodies and other elements which protect the baby against
infections are still there, some in greater quantities than when the baby was younger.

9. S/he tells you that you must never allow your baby to fall asleep at the breast. Why not? It is fine if
a baby can also fall asleep without nursing, but one of the advantages of breastfeeding is that you
have a handy way of putting your tired baby to sleep. Mothers around the world since the beginning
of mammalian time have done just that. One of the great pleasures of parenthood is having a child fall
asleep in your arms, feeling the warmth he gives off as sleep overcomes him. It is one of the
pleasures of breastfeeding, both for the mother and probably also for the baby, when the baby falls
asleep at the breast.

10. S/he tells you that you should not stay in hospital to nurse your sick child because it is important
you rest at home. It is important you rest, and the hospital which is supportive of breastfeeding will
arrange it so that you can rest while you stay in the hospital to nurse your baby. Sick babies do not
need breastfeeding less than a healthy baby, they need it more.

Handout #18. How to know a health professional is...Revised January 1998

Written by Jack Newman, MD, FRCPC

May be copied and distributed without further permission

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